NUMBER OF U.S. FAMILIES SUPPORTED GROWS BUT ONLY 7% OF TOTAL I/DD SPENDING UNITED STATES Family support spending in 2009 constituted 7% of total I/DD long- term care spending ($53.2 billion). Source: Braddock, D., State of the States in Developmental Disabilities, 2012. 52
NUMBER OF OHIO FAMILIES SUPPORTED GROWS BUT ONLY 3% OF TOTAL I/DD SPENDING OHIO Family support spending in 2011 constituted 3% of total I/DD long- term care spending in Ohio ($3.15 billion). Source: Braddock, D., State of the States in Developmental Disabilities, 2012; number of families reported to our study by personnel from the Ohio Department of Developmental Disabilities. 53
22 STATES HAD CASH SUBSIDIES FOR FAMILIES IN 2009—OHIO DID NOT Source: Braddock, D., State of the States in Developmental Disabilities, 2012. 54
II.3B SUPPORTED EMPLOYMENT “While supported employment has made significant gains since its formal introduction in 1984 (P.L. 98-527), segregated services continue to outpace the growth of supported employment nationally.” True in 2004 and true today. (Rusch & Braddock, Research and Practice for Persons with Severe Disabilities , 2004) 55
PER CAPITA* SUPPORTED EMPLOYMENT WORKERS IN OHIO RANKED IN TOP 3 RD OF STATES IN 2009 *Per 100,000 of General Population 56
I/DD SUPPORTED EMPLOYMENT WORKERS GROWS RAPIDLY THEN PLATEAUS UNITED STATES Source: Braddock, D., State of the States in Developmental Disabilities, 2012. 57
I/DD SUPPORTED EMPLOYMENT WORKERS IN OHIO PEAKS IN 2003, THEN DECLINES Source: Braddock, D., State of the States in Developmental Disabilities, 2012. 58
II.3C AGING CAREGIVERS LONGEVITY OF PERSONS WITH I/ DD, THE AGING OF AMERICA, AND AGING I/DD FAMILY CAREGIVERS 59
LONGEVITY INCREASES FOR PERSONS WITH AN INTELLECTUAL DISABILITY • 1970s: 59.1 years • 1993: 66.2 years • U.S. General Population: 70.4 years • In the future “…those without severe impairment can be expected to have a life span equal to that of the general population.” Source : M. Janicki. (1996). Rehabilitation Research and Training Center on Aging and Mental Retardation, University of Illinois at Chicago. 60
AN ESTIMATED 27% OF PERSONS WITH I/DD LIVE AT HOME WITH CAREGIVERS AGED 60 YEARS OR MORE OHIO 61
OHIO RANKS 6 TH IN U.S. IN POPULATION AGED 65+ YEARS, 2010 Source: U.S. Bureau of the Census, 2010 62
AGING POPULATION DOUBLES 2010-40, U.S. AGED 65+ YEARS: 2010-2050 Source: U.S. Bureau of the Census, 2009 63
III. ECONOMIC UNCERTAINTY ECONOMIC UNCERTAINTY IN THE STATES AND THE GREAT RECESSION 64
WHICH STATES ARE CONFIDENT ABOUT THE U.S. ECONOMY? NONE ARE! DC IS! 65
FOUR US RECESSIONS: AGGREGATE STATE GENERAL FUNDS DROP 66
U.S. INDUSTRIAL CAPACITY UTILIZATION: JANUARY 2005-JANUARY 2012 FACTORIES, UTILITIES, MINES 67
STATE BUDGETARY SHORTFALLS:2002-12 68
STATE BUDGET SHORTFALLS FOR FY 2012 69
STATE TAX REVENUE FELL FROM 2008 Q2 THROUGH 2009 Q2. REBOUNDED TO 2011 Q 2 – BUT DOWN Q3 Source: The Nelson A. Rockefeller Institute of Government, January 2012. 70
STATES’ SALES TAX REVENUES INCREASE 6.1% IN 3 rd QUARTER OF 2011 Source: The Nelson A. Rockefeller Institute of Government, January 2012. 71
AGGREGATE PERSONAL INCOME GREW 3.4% 2010-12, BUT REMAINS BELOW 2005 LEVEL Source: Bureau of Economic Analysis, U.S. Department of Commerce (2012). 72
ECONOMIC MOMENTUM IN THE STATES: TOP FIVE AND BOTTOM FIVE 73
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POPULATION MIGRATION IN THE STATES: 2006-09 Source: Federal Funds Information for States (2009). State Policy Reports, Vol. 27 , No. 21. 75
IV. THE FUTURE: EMERGING TECHNOLOGIES “I think we can do a ‘virtual nursing home’ with technology”… Andy Grove Co-Founder, Intel Corp. In USA Today , 2006 76
PROJECTED U.S.GROWTH IN RESIDENTIAL SERVICES IN THE NEXT DECADE: 165.6k Projected from 2000-2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2012. 77
INTEGRATED WIRELESS SENSOR NETWORKS IN THE FUTURE: A combination of wireless cell phone, Internet, and sensor technology will connect people, objects, and events. Smart homes/care will play key roles in assisted living for persons with I/DD, allowing seamless connectivity between clients, caregivers/health care providers, and parents. 78
MIT PLACELAB - BEHIND THE SCENES Context-aware PDA with wireless sensors/motes Source: MIT PlaceLab website at http://architecture.mit.edu/house_n/placelab.html 79
U.S. SMART HOME SERVICE PROVIDERS FOR PERSONS WITH ID • IMAGINE! BOULDER AND LONGMONT COLORADO • REST ASSURED, LLC. • SOUND RESPONSE, MADISON, WISCONSIN Source: Braddock, D., Coleman Institute, University of Colorado, 2010. 80
IMAGINE! SMART HOME, BOULDER, COLORADO: COMPLETED 2009 Imagine! Smart Homes in Boulder and Longmont, Colorado http://www.imaginesmarthomes.org/ 81
IMAGINE! SMART HOME, BOULDER, COLORADO: GREEN TECHNOLOGIES Photovoltaic cells generate electricity Geothermal systems heat and cool the home 82
IMAGINE! SMART HOME, LONGMONT, CO, OPENED MAY 2010 Imagine! Smart Homes in Boulder and Longmont, Colorado http://www.imaginesmarthomes.org/ 83
FUNDING FOR HOMES • Private donations • HUD • Cities of Boulder and Longmont • State of Colorado/Medicaid 84
IMAGINE! SMART HOMES, BOULDER/ LONGMONT STAFF SYSTEMS • Employee/manager portal for centralized information collection and reporting • Web-based medication prompt system • Location based activity prompting/logging • Web based training courses • Lifelogging of resident histories • Family portal for daily activities and health status with text and picture-sharing 85
IMAGINE! SMART HOMES, BOULDER/ LONGMONT CONSUMER, ENVIRONMENTAL AND COMMUNICATIONS ADAPTATIONS • Accessible control of environment and appliances • Accessible, safe kitchen and bathroom • Cameras monitor high-risk areas • Automated windows and doors • Task prompters and reminders • Specialized, accessible PC, Internet, journaling and web conferencing 86
REST ASSURED PROGRAM Staff person monitors several apartments simultaneously. 87
REST ASSURED PROGRAM • Uses PTZ (Pan, Tilt, Zoom) cameras for monitoring in high risk areas like the kitchen • Remote supervision via two-way audio/video communication with caregiver • Motion, temperature, carbon monoxide, and door brake sensors used in, in addition to a Personal Emergency Response System • Consumers report increased independence; caregiver is not a constant physical presence in the house • Reduced overall cost of care • Currently used primarily for third-shift support Source : Rest Assured, Wabash, Indiana. 88
REST ASSURED PROGRAM–ATTRIBUTES • Developed in collaboration with EPICS (Engineering Projects In Community Service) at Purdue University • Serves consumers with ID • Nearly 300 homes and apartments with over 400 consumers served in eight states: FL, GA, IL, IN, KS, MD, OH, & WI Source : Dustin Wright, General Manager, Rest Assured LLC, Wabash, Indiana. 89
SOUND RESPONSE SYSTEMS: MADISON • Professional Monitors • Communication between Monitor and staff/ individuals served • Access to protocols and personal intervention strategies • Provider agency back-up • Individualized alarm readings • Generates reports 90
EQUIPMENT FEATURES Completely Wireless in the Home Cellular Transmission- No Phone or Internet Connection is Required 2-Way Communication Event Sequencing Data Tracking Portable and Adaptable to People’s Homes and Abilities 91
INDIANA GOVERNOR MITCH DANIELS ENDORSES SMART HOME TECHNOLOGY “We can alleviate some of the demand for Direct Support Professionals (DSPs) by identifying new service options for people who do not need intensive DSP support. The system is tailored to the needs of each person who uses it and has been shown to improve personal independence, as well as alleviating the needs for a direct support professional where one is not needed.” Mitch Daniels, Governor, State of Indiana The Arc of Indiana, Meet the Candidates , Summer 2008 92
STATES WITH MEDICAID SUPPORT FOR SMART HOME TECHNOLOGIES MEDICAID WAIVER AMENDMENT APPROVED • INDIANA, KANSAS, LOUISIANA, OHIO*, WEST VIRGINIA STATES EXPRESSING INTEREST • KENTUCKY, MASSACHUSETTS, NEW JERSEY * Ohio’s Individual Options Waiver includes payment for equipment used to operate systems such as live video feed, live audio feed, motion sensing system, radio frequency identification, web-based monitoring system…and equipment used to engage in live two-way communication with the individual being monitored…Ohio will collect data to determine if the proposed amount is reasonable. 93
PDA TASK PROMPTING SOFTWARE Visual Assistant (Prompting System) Source : Ablelink Technologies, Colorado Springs (Terry & Jonathan). 94
VISUAL ASSISTANT A pocket personal computer with an integrated PC-slot digital camera; Staff/caretakers take pictures of— and narrate--the steps in a task; The verbal instructions and images guide users through the steps: – Grocery shopping – Medications – Personal hygiene – Using public transportation, etc. SOURCE: Ablelink Technologies, Colorado Springs. 95
ADAPTED WEB BROWSER AND E-MAIL Adapted Web Browser Adapted E-mail Program The Web Trek adapted web browser improves access to the World Wide Web for people who have difficulty with reading and writing. SOURCE: Ablelink Technologies, Colorado Springs. 96
ROCKET READER AUDIO BOOKS Source: Ablelink Technologies, Colorado Springs; www.ablelinktech.com 97
LOCATION TRACKING Nextel mobile locator: http://www.nextel.com/en/services/gps/mobile_locator Wherifone: http://www.wherify.com/wherifone/ Accutracking: http://www.accutracking.com/ 911 to go: http://www.travelbygps.com/articles/tracking.php / Contact your cell phone provider for phones/services 98
TREKKER BREEZE GPS Verbally announces the names of streets, intersections and landmarks as you walk. Source: http:// www.visabilitystore.org/ browse.cfm/trekker-breeze- gps/ 99
INDOOR WAYFINDING SUPPORT Participants preferred images with arrows, not audio alone [In Development] SOURCE: http://cognitivetech.washington.edu/assets2006_liu.pdf . 100
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